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Singh DK, Sinha K, Kaif M, Yadav K, Singh N, Chand VK, Sharma PK, Singh N, Dabbir VK. Endovascular Management of Vertebro-Vertebral Arteriovenous Fistula (VVAVF) with Trapping of the Vertebral Artery. Neurol India 2023; 71:898-901. [PMID: 37929424 DOI: 10.4103/0028-3886.388065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Deepak K Singh
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kshitij Sinha
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mohammad Kaif
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuldeep Yadav
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neha Singh
- Department of Radiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vipin K Chand
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prevesh K Sharma
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nirbhay Singh
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Virinchi K Dabbir
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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2
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Zhao J, Zhao G, Lu L, Li C, Yang R. Vertebral arteriovenous fistulae (AVF) and vertebral artery aneurysms in neurofibromatosis type 1: A case report and a systematic review. Medicine (Baltimore) 2022; 101:e30952. [PMID: 36221365 PMCID: PMC9543027 DOI: 10.1097/md.0000000000030952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is caused by mutations in the NF1 gene on the long arm of chromosome 17, which affects the skin, nervous system, eyes, and skeleton system. Vertebral arteriovenous fistula (AVF) associated with neurofibromatosis type I (NF-1) is rare. CASE PRESENTATION We report a 31-year-old postpartum woman with NF1 with vertebral arteriovenous fistulae (AVFs). She presented to our hospital because of neck pain, intracranial hypotension headache, and right upper limb weakness. She had a family history of NF1. After endovascular intervention, the AVF disappeared. However, a new aneurysm appeared on the right vertebral artery V5 dissection after 6 months of follow-up. CONCLUSIONS The presence of NF1 in patients who present with neurologic signs should prompt further angiography. Awareness of the coexistence between NF1 and AVF or aneurysm is crucial to avoiding diagnostic delays. Endovascular occlusion of VV-AVF in NF-1 patients is effective and safe.
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Affiliation(s)
- Jiali Zhao
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
- *Correspondence: Jiali Zhao, Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan 250021, Shandong, China (e-mail: )
| | - Guangyu Zhao
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Lin Lu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
| | - Chunxia Li
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
| | - Ruirui Yang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
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3
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Chen J, Liang T, Cen J, Jiang J, Chen T, Li H, Liu C, Chen J, Zhan X. Extracranial Vertebral Artery-Internal Jugular Vein-Spinal Vein Fistula in Neurofibromatosis Type I: Case Report and Literature Review. Front Neurol 2022; 13:855924. [PMID: 35572928 PMCID: PMC9104120 DOI: 10.3389/fneur.2022.855924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/28/2022] [Indexed: 11/21/2022] Open
Abstract
Background A cervical arteriovenous fistula (AVF) in neurofibromatosis type I (NF-1) is uncommon, and it brings challenges and difficulty in treatment. Case Presentation A 39-year-old woman was diagnosed with an NF-1-associated spontaneous vertebral artery-internal jugular vein-spinal vein fistula. The fistula was placed by coil embolization. Postoperative examination showed that the fistula closure was satisfied, and the patient's abnormal clinical manifestation disappeared without any complications after 24 months of interventional embolization. As per the literature, interventional embolization is currently the main treatment method, and it has the distinguishing features of less trauma, quick recovery, and a good prognosis. Conclusion NF-1 associated with a spontaneous arteriovenous fistula is rare in clinical practice, which carries significant challenges in treatment, but can be effectively treated using endovascular embolism. Endovascular embolism could be the potential choice of treatment in NF-1 associated with AVF.
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Affiliation(s)
- Jiarui Chen
- Department of Spine and Osteopathic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tuo Liang
- Department of Spine and Osteopathic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jiemei Cen
- Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- *Correspondence: Jiemei Cen
| | - Jie Jiang
- Department of Spine and Osteopathic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tianyou Chen
- Department of Spine and Osteopathic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hao Li
- Department of Spine and Osteopathic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chong Liu
- Department of Spine and Osteopathic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jing Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Jing Chen
| | - Xinli Zhan
- Department of Spine and Osteopathic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Xinli Zhan
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Endovascular treatment of vertebro-vertebral arteriovenous fistula in neurofibromatosis type I: A report of two cases and literature review with a focus on endovascular treatment. Clin Neurol Neurosurg 2021; 207:106806. [PMID: 34293658 DOI: 10.1016/j.clineuro.2021.106806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 11/22/2022]
Abstract
Vertebro-Vertebral arteriovenous fistula (VV-AVF) associated with neurofibromatosis Type I (NF-1) is rare. We presented two female NF-1 patients with a diagnosis of VV-AVF treated with endovascular approach. The fistula was completely obliterated with balloon assisted embolization and covered stent separately and VA patency was preserved in both cases. Reviewing the literature with a focus on endovascular treatment, endovascular occlusion of VV-AVF in NF-1 patients is safe and effective. To preserve the parent VA patency and obliterate the fistula simultaneously is challenging generally, but feasible in some cases.
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5
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Furuta T, Nakagawa I, Park H, Nakase K, Yokoyama S, Kotsugoi M, Takeshima Y, Nakase H. Thoracolumbar intraosseous spinal epidural arteriovenous fistulas after vertebral compression fracture: A case report and literature review. Surg Neurol Int 2021; 12:270. [PMID: 34221601 PMCID: PMC8247718 DOI: 10.25259/sni_349_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022] Open
Abstract
Background: The pathophysiology of spinal epidural arteriovenous fistulas (SEAVFs) with perimedullary venous drainage remains to be elucidated. This report describes a case of intraosseous SEAVF in a patient with a history of a thoracolumbar vertebral fracture at the same level 10 years before presenting with progressive myelopathy secondary to retrograde venous reflux into the perimedullary vein. Case Description: A 71-year-old man presenting with progressive paraparesis was diagnosed with a SEAVF involving a previous Th12 and L1 vertebral compression fracture on which feeders from multiple segmental arteries converged. The interesting feature of this case was that the fistula was located in the fractured vertebral body. The fistula was totally obliterated by transarterial embolization of the segmental arteries followed by symptom improvement. Conclusion: We presented a rare case of an intraosseous SEAVF secondary to a thoracolumbar compression fracture with perimedullary venous reflux causing progressive myelopathy. The fistula was located in the fractured vertebral body.
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Affiliation(s)
- Takanori Furuta
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - HunSoo Park
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Kenta Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Masashi Kotsugoi
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | | | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
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Kim JH, Yoon SH, Park SQ, Ban SP, Cho BK. Clinical features and treatment strategy of paraspinal arteriovenous shunt (PAVS): a systematic review with individual participants data meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2385-2400. [PMID: 33893553 DOI: 10.1007/s00586-021-06831-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Because of the rarity of the disease, paraspinal arteriovenous shunt (PAVS) is not well recognized, and therapeutic options remain controversial. To introduce a rare disease of PAVS and demonstrate its etiology, clinical features, treatment options, and outcomes, we presented a case report and conducted a systematic review and individual participants data (IPD) meta-analysis. METHODS Studies regarding on PAVS were integrated and IPD were obtained including patients' demographics, disease etiology, clinical and radiologic features, clinical courses and outcomes. Clinical manifestation and treatment outcomes were reviewed, and comparison analysis (cervical versus thoracolumbar) were performed. Further, logistic regression analyses were conducted to identify the poor prognostic factors (incomplete obliteration). RESULTS Fifty-two articles were selected, and 88 patients enrolled. General and location-specific characteristics of PAVSs were identified: '3/4 of the isolated and 1/4 of the associated etiology', 'bruit, thrill, or murmur (cervical) and weakness (thoracolumbar) as common symptoms', '40% multiple feeders', and '22% intradural venous involvement'. Endovascular treatment was usually preferred (75%). Of 88 enrolled patients, 18 patients showed incomplete obliteration (20.5%). In multivariate analysis, 'etiologies of systematic genetic dysplasia (P = 0.031) and trauma (negatively, 0.038)' were significantly associated with incomplete obliteration. The parameters of 'multiple feeders (0.066)' and 'combined approach (negatively, 0.065)' are verified only in univariate analysis. CONCLUSION General as well as location-specific characteristics of PAVS is successfully demonstrated. Approximately 20% of the incomplete obliteration is noted, and three potential poor prognostic factors are identified, namely, 'etiology of systematic genetic dysplasia (positive) and trauma (negative)', 'combined approach (negative), and 'multiple feeders'.
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Affiliation(s)
- Jang Hun Kim
- Department of Neurosurgery, Armed Forces Capital Hospital, Gyeonggi-do, Republic of Korea
| | - Sang Hoon Yoon
- Department of Neurosurgery, Armed Forces Capital Hospital, Gyeonggi-do, Republic of Korea.
| | - Suhk Que Park
- Department of Neurosurgery, Sooncheonhyang Seoul University Hospital, Seoul, Republic of Korea
| | - Seung-Pil Ban
- Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, Armed Forces Capital Hospital, Gyeonggi-do, Republic of Korea
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7
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Swain SK, Arora RK, Sharma SK, Nandolia K, Basu G, Rekhapalli R, Arora P, Rajpal G, Sherwani P, Saxena S, Mittal RS. Vertebral arteriovenous fistulae in neurofibromatosis type1: a systematic review and meta-analysis. J Neurosurg Sci 2021; 66:54-61. [PMID: 33870666 DOI: 10.23736/s0390-5616.21.05232-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Vertebral Arterio-venous fistulas (VAVFs) are uncommon lesions that can arise spontaneously or secondarily to iatrogenic or mechanical trauma. Among spontaneous cases, it is most commonly found to be associated with Neurofibromatosis type 1 (NF1). EVIDENCE ACQUISITION We performed a systematic review of the literature to obtain information regarding demographics, clinical presentation, treatment modalities and outcome of VAVFs associated with NF1. A literature search was performed by using databases PubMed Central, Embase, Cochrane Library, and Ovid MEDLINE. Also, the grey area search was done using the "Google Scholar" search engine. On screening of the original full-text English language articles, a total of 48 cases were considered suitable for inclusion in this review. EVIDENCE ANALYSIS VAVFs in NF1 commonly present between 3rd and 6th decade of life affecting females 2.4 times more than males. Left-sided fistulae were more common than the right side and most seen in the upper V2 segment of the vertebral artery. Most VAVFs in NF 1 patients were treated with constructive (occlusion of fistula only) endovascular therapy (n =26) with a high success rate. Moreover, Pooled proportion of the outcome data have shown significant difference between the endovascular constructive and destructive procedure. CONCLUSIONS The spontaneous VAVF, commonly associated with NF-1, often requires treatment. Awareness of the coexistence between NF1 and VAVF is crucial to avoid diagnostic delays and unnecessary surgical intervention leading to disastrous outcomes. Endovascular treatment is the preferred treatment approach while open surgical treatment is required in some complex fistulae and failure of endovascular techniques.
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Affiliation(s)
- Srikant K Swain
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Rajnish K Arora
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India -
| | | | - Khanak Nandolia
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, India
| | - Garga Basu
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Rajasekhar Rekhapalli
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Poonam Arora
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Rishikesh, India
| | - Girish Rajpal
- Neurointerventionist, Max Healthcare, New Delhi, India
| | - Poonam Sherwani
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, India
| | - Sudhir Saxena
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, India
| | - Radhey S Mittal
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India
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8
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Wang Y, Yuan C, Shen S, Zhang Y, Zhang J, Duan H. Case Report: Multi-Orifices Vertebral Arteriovenous Fistula With Severe Scoliosis in Neurofibromatosis Type 1: Might Be a Congenital Disease With Mesodermal Dysplasia. Front Neurol 2021; 12:578797. [PMID: 33815242 PMCID: PMC8010312 DOI: 10.3389/fneur.2021.578797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Vertebral arteriovenous fistula (AVF) associated with neurofibromatosis type 1 (NF-1) is a rare condition in the previous reports. However, whether vertebral AVF in NF-1 is congenital or NF-1 disease progression hasn't been clarified. Case Description: We reported a 48-year-old male case of vertebral AVF simultaneously combined with thoracic scoliosis and NF-1. Preoperative CT angiography showed the AVF with multiple orifices located on the vessel wall of the vertebral artery, which was proved during the procedure of endovascular treatment. By occluding the parent vertebral artery, the AVF was finally cured. Further whole-exome sequencing identified a novel germline heterozygous point nonsense mutation, c.G397T(p.E133X), in the NF1(NM_000267) gene exon4. Conclusions: From this patient, we speculate that vertebral AVF associated with NF-1 might be a congenital disease as a manifestation of mesodermal dysplasia.
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Affiliation(s)
- Yingjin Wang
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Changwei Yuan
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Shengli Shen
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Yang Zhang
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Jiayong Zhang
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Hongzhou Duan
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
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9
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Nishizawa T, Tsuchiya T, Terasawa Y, Osugi Y. Neurofibromatosis type 1 with subarachnoid haemorrhage from the left vertebral arteriovenous fistula: case presentation and literature review. BMJ Case Rep 2021; 14:14/2/e239880. [PMID: 33619142 PMCID: PMC7903112 DOI: 10.1136/bcr-2020-239880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 47-year-old woman with neurofibromatosis type 1 (NF1) with subarachnoid haemorrhage (SAH) from the left vertebral arteriovenous fistula, along with a review of previous cases. Our patient had a family history of NF1 and presented to the emergency department with a sudden-onset severe headache and neck pain. CT scan showed SAH. CT angiography revealed a left vertebral arteriovenous fistula and an epidural haematoma. She underwent direct surgery and was discharged without neurologic deficits. To our knowledge, this is the first case of SAH caused by perimedullary drainage of a vertebral arteriovenous fistula associated with NF1. In a literature search, we identified 40 cases of vertebral arteriovenous fistula associated with NF1. The majority of vertebral arteriovenous fistulas occurred on the left side and in women. Patients with vertebral arteriovenous fistula typically experience neck pain, radiculopathy, radiculomyelopathy and bruits.
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Affiliation(s)
- Toshinori Nishizawa
- Department of General Internal Medicine, St Luke's International University, Chuo-ku, Japan .,Department of General Internal Medicine, Toyota Regional Medical Center, Toyota, Aichi, Japan
| | - Takahiro Tsuchiya
- Department of Neurosurgery, Tokyo University Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yoshihiro Terasawa
- Department of General Internal Medicine, Toyota Regional Medical Center, Toyota, Aichi, Japan,Department of General Internal Medicine, Kuchinotsu Hospital, Minamishimabara, Nagasaki, Japan
| | - Yasuhiro Osugi
- Department of General Internal Medicine, Toyota Regional Medical Center, Toyota, Aichi, Japan,Department of Community Based Medicine, Fujita Health University, Toyoake, Aichi, Japan
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10
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Carpenter K, Decater T, Iwanaga J, Maulucci CM, Bui CJ, Dumont AS, Tubbs RS. Revisiting the Vertebral Venous Plexus-A Comprehensive Review of the Literature. World Neurosurg 2020; 145:381-395. [PMID: 33049379 DOI: 10.1016/j.wneu.2020.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/23/2022]
Abstract
The venous drainage of the vertebral and paravertebral regions is important for a better understanding of hematogenous disease spread. Moreover, the spine surgeon must be well acquainted with this anatomy to minimize intraoperative and postoperative complications. A comprehensive review of the vertebral venous plexus (Batson plexus) was performed with a concentration on the clinical and surgical correlations of this venous network.
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Affiliation(s)
- Kennedy Carpenter
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Tess Decater
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Christopher M Maulucci
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - C J Bui
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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11
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Dote K, Takahashi N, Niki T, Ishiguro T, Shiojima I. A case of vertebral arteriovenous fistula in a patient undergoing maintenance hemodialysis. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0185-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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12
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Maki Y, Ishibashi R, Fukuda H, Kobayashi M, Chin M, Yamagata S. Subarachnoid Hemorrhage from Vertebral Arteriovenous Fistula without Perimedullary Drainage: Rare Stroke Hemorrhagic Event in a Patient of Neurofibromatosis Type 1. Neurol Med Chir (Tokyo) 2018; 58:185-188. [PMID: 29479040 PMCID: PMC5929917 DOI: 10.2176/nmc.cr.2017-0241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Vertebral arteriovenous fistula (VAVF), which can cause subarachnoid hemorrhage (SAH) when having a perimedurally drainage, has been reported as a rare vascular abnormality in patients with neurofibromatosis type 1 (NF-1). In addition, extracranial vertebral aneurysm (EVAn) coexisting with VAVF and NF-1 is considered rare, and further complication with SAH is extremely rare in patients. There is only one reported case of NF-1 complicated with SAH from VAVF with an EVAn. Here, we present a case of a middle-aged patient with NF-1. The VAVF accompanied by an EVAn was detected with an episode of SAH. The VAVF with an EVAn in our case was accompanied with an epidural varix, lacking of perimedullary drainage, which could be a cause for SAH. We speculate the mechanism of SAH from the VAVF with an EVAn lacking of perimedurally drainage, focusing on hemodynamic stress of the VAVF and the tissue fragility related to NF-1.
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Affiliation(s)
| | | | | | | | - Masaki Chin
- Department of Neurosurgery, Kurashiki Central Hospital
| | - Sen Yamagata
- Department of Neurosurgery, Kurashiki Central Hospital
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13
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Kim ST, Brinjikji W, Lanzino G, Kallmes DF. Neurovascular manifestations of connective-tissue diseases: A review. Interv Neuroradiol 2016; 22:624-637. [PMID: 27511817 DOI: 10.1177/1591019916659262] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/22/2016] [Indexed: 12/20/2022] Open
Abstract
Patients with connective tissue diseases are thought to be at a higher risk for a number of cerebrovascular diseases such as intracranial aneurysms, dissections, and acute ischemic strokes. In this report, we aim to understand the prevalence and occurrences of such neurovascular manifestations in four heritable connective tissue disorders: Marfan syndrome, Ehlers-Danlos syndrome, Neurofibromatosis Type 1, and Loeys-Dietz syndrome. We discuss the fact that although there are various case studies reporting neurovascular findings in these connective tissue diseases, there is a general lack of case-control and prospective studies investigating the true prevalence of these findings in these patient populations. Furthermore, the differences observed in the manifestations and histology of such disease pathologies encourages future multi-center registries and studies in better characterizing the pathophysiology, prevalence, and ideal treatment options of neurovascular lesions in patents with connective tissue diseases.
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14
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Narayana RV, Pati R, Dalai S. Endovascular management of spontaneous vertebrovertebral arteriovenous fistula associated with neurofibromatosis 1. Indian J Radiol Imaging 2015; 25:18-20. [PMID: 25709160 PMCID: PMC4329681 DOI: 10.4103/0971-3026.150132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Extra cranial vertebrovertebral arteriovenous fistulas (VV AVF) are commonly associated with trauma. Their presentation may vary from palpable thrill and myelopathy or myeloradiculopathy. Sudden onset paraparesis is rare.
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Affiliation(s)
- Randhi Venkata Narayana
- Department of Neurology and Interventional Neuroradiology, Seven Hills Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Rajesh Pati
- Department of Neurology and Interventional Neuroradiology, Seven Hills Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Sibasankar Dalai
- Department of Neurology and Interventional Neuroradiology, Seven Hills Hospital, Visakhapatnam, Andhra Pradesh, India
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15
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Abstract
Object
Our understanding of spinal extradural arteriovenous fistulas (eAVFs) is relatively limited. In this study the authors aimed to provide the demographics, natural history, and treatment results of these rare lesions.
Methods
The authors performed a pooled analysis of data in the PubMed database through December 2012. Individualized patient data were extracted to elucidate demographic, clinical, and angioarchitectural features of spinal eAVFs as well as outcomes following different treatment strategies.
Results
Information on 101 patients was extracted from 63 eligible studies. The mean patient age was 45.9 years, and there was no significant overall sex predilection. Only 3% of the lesions were incidental, whereas 10% occurred in patients who had presented with hemorrhage. None of the 64 patients with at least 1 month of untreated follow-up sustained a hemorrhage over a total of 83.8 patient-years. Patients with lumbosacral eAVFs were significantly older (mean age 58.7 years, p < 0.0001), were significantly more often male (70% male, p = 0.02), had significantly worse presenting Aminoff-Logue motor and bladder scores (p = 0.0008 and < 0.0001, respectively), and had the greatest prevalence of lesions with intradural venous drainage (62% of cases, p < 0.0001). Neurofibromatosis Type 1 (30% of cases, p < 0.0001) and subarachnoid hemorrhage (9% of cases, p = 0.06) were associated with and exclusively found in patients with cervical eAVFs. The overall complete obliteration rate was 91%. After a mean follow-up of 1.7 years, the clinical condition was improved in 89% of patients, the same in 9%, and worse in 2%. Obliteration rates and outcome at follow-up did not significantly differ between surgical and endovascular treatment modalities.
Conclusions
Spinal eAVFs are rare lesions with a low risk of hemorrhage; they cause neurological morbidity as a result of mass effect and/or venous hypertension. Their treatment is associated with a high rate of complete obliteration and improvement in preoperative symptoms.
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16
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Briganti F, Tedeschi E, Leone G, Marseglia M, Cicala D, Giamundo M, Napoli M, Caranci F. Endovascular treatment of vertebro-vertebral arteriovenous fistula. A report of three cases and literature review. Neuroradiol J 2013; 26:339-46. [PMID: 23859293 DOI: 10.1177/197140091302600315] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/02/2013] [Indexed: 11/16/2022] Open
Abstract
This report describes endovascular approaches for occlusion of vertebro-vertebral arteriovenous fistula (VV-AVF) in a series of three cases and a review of the literature. Complete neuroimaging assessment, including CT, MR and DSA was performed in three patients (two female, one male) with VV-AVF. Based on DSA findings, the VV-AVF were occluded by endovascular positioning of detachable balloons (case 1), coils (case 2), or a combination of both (case 3) with parent artery patency in two out of three cases. In this small series, endovascular techniques for occlusion of VV-AVF were safe and effective methods of treatment. To date, there are no guidelines on the best treatment for VV-AVF. Detachable balloons, endovascular coiling, combined embolization procedures could all be considered well-tolerated treatments.
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Affiliation(s)
- F Briganti
- Department of Diagnostic Imaging, University of Naples, Naples, Italy.
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17
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TERAMOTO S, OISHI H, YOSHIDA K, YAMAMOTO M, OHARA Y, ARAI H. Paravertebral Arteriovenous Fistula Treated by Endovascular Coil Embolization. Neurol Med Chir (Tokyo) 2012; 52:510-2. [DOI: 10.2176/nmc.52.510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Hidenori OISHI
- Department of Neurosurgery, Juntendo University School of Medicine
| | - Kensaku YOSHIDA
- Department of Neurosurgery, Juntendo University School of Medicine
| | | | - Yukoh OHARA
- Department of Neurosurgery, Juntendo University School of Medicine
| | - Hajime ARAI
- Department of Neurosurgery, Juntendo University School of Medicine
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18
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Zhong H, Shao G. Vertebral arteriovenous fistula. J Vasc Surg 2011; 53:492. [DOI: 10.1016/j.jvs.2010.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 02/02/2010] [Accepted: 02/14/2010] [Indexed: 11/28/2022]
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19
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Higa G, Pacanowski JP, Jeck DT, Goshima KR, León LR. Vertebral artery aneurysms and cervical arteriovenous fistulae in patients with neurofibromatosis 1. Vascular 2010; 18:166-77. [PMID: 20470689 DOI: 10.2310/6670.2010.00032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vascular involvement in the setting of neurofibromatosis type 1(NF1) has been well described. However, the coexistence of NF1 with vertebral artery (VA) aneurysms and arteriovenous fistulae (AVFs) is a rare occurrence. A 60-year-old female with NF1 and other severe comorbidities presented with acute respiratory insufficiency caused by a ruptured large VA aneurysm and an associated AVF that required emergent intubation and eventual repair through endovascular techniques that resolved her symptoms. A detailed description of this case and a comprehensive review of the literature are also presented.
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20
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Ihn YK, Jung WS, Kim BS. Endovascular Treatment for Spontaneous Vertebral Arteriovenous Fistula in Neurofibromatosis Type 1: A Case Report. Neurointervention 2010. [DOI: 10.5469/neuroint.2010.5.2.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yon Kwon Ihn
- Department of Radiology, Catholic University of Korea, Seoul, Korea
| | - Won Sang Jung
- Department of Radiology, Catholic University of Korea, Seoul, Korea
| | - Bum-Soo Kim
- Department of Radiology, Catholic University of Korea, Seoul, Korea
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21
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Patro SN, Gupta AK, Arvinda HR, Jolapara MB, Saini J. Combined transarterial and percutaneous coiling of a spontaneous vertebrovertebral fistula associated with neurofibromatosis Type 1. J Neurosurg 2009; 111:37-40. [DOI: 10.3171/2008.12.jns081209] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report a rare case of spontaneous left vertebrovertebral fistula associated with neurofibromatosis Type 1 in a young woman. The patient had undergone previous failed surgical attempts to close the fistula and presented to the authors with recurrence of the fistula and neurological deterioration. Successful obliteration of the fistula with combined transarterial and percutaneous coiling with Guglielmi detachable coils resulted in disappearance of the fistula and significant neurological improvement.
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22
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Kawabori M, Hida K, Yano S, Asano T, Iwasaki Y. Cervical epidural arteriovenous fistula with radiculopathy mimicking cervical spondylosis. Neurol Med Chir (Tokyo) 2009; 49:108-13. [PMID: 19318735 DOI: 10.2176/nmc.49.108] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 65-year-old woman presented with a rare case of cervical epidural arteriovenous fistula (AVF) manifesting as radiculopathy of the right upper extremity that mimicked cervical spondylosis. She had a 2-month history of gradually progressive right-hand motor weakness and sensory disturbance. The initial diagnosis was cervical disk herniation. However, computed tomography with contrast medium showed abnormal enhancement at the right C5-6 and C6-7 intervertebral foramina. Magnetic resonance (MR) imaging with gadolinium disclosed an enhanced abnormal epidural mass at the dorsal surface of the dural tube between the C5 and C6 vertebrae. T(2)-weighted MR imaging showed a slight flow void on the dorsal and ventral surfaces of the spinal cord between C3 and T4. Digital subtraction angiography disclosed cervical epidural and dural AVFs fed by the C5 and C6 radicular arteries. The diagnosis was concomitant epidural and dural AVFs. The dilated internal vertebral venous plexus attributable to epidural AVF was considered to be responsible for the radiculopathy. Transarterial embolization using n-butylcyanoacrylate achieved complete occlusion of the lesions. Her symptoms improved immediately and MR imaging and angiography performed 10 days postembolization showed reduction of both the epidural and dural AVFs.
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Affiliation(s)
- Masahito Kawabori
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Hokkaido, Japan.
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23
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Paolini S, Colonnese C, Galasso V, Morace R, Tola S, Esposito V, Cantore G. Extradural arteriovenous fistulas involving the vertebral artery in neurofibromatosis Type 1. J Neurosurg Spine 2008; 8:181-5. [DOI: 10.3171/spi/2008/8/2/181] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ Spinal extradural arteriovenous fistulas (AVFs) are rare lesions that may be associated with neurofibromatosis Type 1 (NF1). In these patients, the shunt typically occurs between the V2 segment of the vertebral artery and the epidural venous plexus. Previously, reported cases have been treated either by using endovascular embolization or, sporadically, by open surgery. In surgical reports, proximal deafferentation or manipulation of the venous portion of the shunt—including suture, resection, or open embolization of the epidural ectasia—was attempted with variable results. The authors report on a case of a young patient with NF1 who underwent emergency surgical disconnection of a cervical extradural AVF after previously unsuccessful endovascular and surgical therapy. The lesion drained into a giant intrathecal varix, causing severe myelopathy. After surgery, the patient recovered almost completely. This experience clarified the surgical anatomy of these malformations and showed that, when surgery is necessary, the optimal treatment providing complete and permanent cure of this condition is direct closure of the epidural shunt pedicle.
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Affiliation(s)
- Sergio Paolini
- 1Department of Neurosurgery, IRCCS Neuromed Pozzilli, University of Perugia; and
| | | | | | - Roberta Morace
- 3Neurosurgery, IRCCS Neuromed Pozzilli, University of Rome “La Sapienza,” Rome, Italy
| | - Serena Tola
- 3Neurosurgery, IRCCS Neuromed Pozzilli, University of Rome “La Sapienza,” Rome, Italy
| | - Vincenzo Esposito
- 3Neurosurgery, IRCCS Neuromed Pozzilli, University of Rome “La Sapienza,” Rome, Italy
| | - Giampaolo Cantore
- 3Neurosurgery, IRCCS Neuromed Pozzilli, University of Rome “La Sapienza,” Rome, Italy
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